Provider First Line Business Practice Location Address:
121 S COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTUMWA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52501-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-684-2225
Provider Business Practice Location Address Fax Number:
641-684-1334
Provider Enumeration Date:
06/06/2006